| Background and ObjectiveSometimes it is difficult to identify parathyroid glands during thyroidectomy.Accidental excision and injury of the parathyroid glands may lead to postoperative hypocalcemia,followed by numbness in the hands and feet,which was one of the common complications of thyroid surgery.In the operation of hyperparathyroidism,the pathological parathyroid should be completely removed to prevent the second operation.The aim of this study was to evaluate the efficacy of near-infrared fluorescence(NIRF)technology in the recognition of intraoperative parathyroid glands,to analyze the potential influencing factors of parathyroid fluorescence intensity(FI),and to further explore the clinical value of NIRF.MethodsA total of 243 patients undergoing thyroid and parathyroid surgery in the Department of Thyroid Surgery,the First Affiliated Hospital of Zhengzhou University from April 2019 to September 2019 were selected as subjects,including 26 males and 94 females,aged 18?75 years old.White light(WL)and NIRF were used to identify the parathyroid glands and the images were recorded.Preoperative,intraoperative and postoperative clinical data were collected.Student-t test was used to analyze the difference in the number of parathyroid glands identified by WL and NIRF.Chi-square was used to analyze the difference in the recognition rate of WL and NIRF on parathyroid glands during operation.Student-t test,variance analysis,spearman rank correlation and univariate regression analysis were used to analyze the influencing factors of standardized parathyroid fluorescence intensity(FI).ResultsAmong the 120 patients,46(38.33%)patients received unilateral surgery and 74(61.66%)patients received bilateral surgery,A total of 350 parathyroid glands were detected and a total of 254 parathyroid glands were detected by both WL and NIRF.A total of 24 parathyroid glands identified by WL but not by NIRF were identified by fine-needle aspiration.There were 72 parathyroid glands identified by fine-needle aspiration among the parathyroid glands detected by NIRF but not by WL.NIRF recognized 0.4 parathyroid glands more than WL on average(2.32±0.917 vs 2.72±1.030,?2=27.815,P<0.001),and the recognition rate of intraoperative parathyroid glands by NIRF was significantly higher than WL(93.13%vs 79.43%,?2=27.815,P<0.001).Among the five types of diseases included,the recognition rate of SHPT parathyroid glands by NIRF was 30%,which was significantly lower than that of PTC(97.03%,?2=101.301,P<0.001),PTC combined with NG(96.88%,?2=39.966,P<0.001),NG(94.74%,P<0.001),and PHPT(100%,P<0.001).It has no difference in the detection rate of parathyroid glands by NIRF among PTC,PTC combined with NG,NG,and PHPT(all P values were greater than 0.05).Parathyroid gland FI(64.08±23.71)was significantly higher than thyroid FI(47.17±23.69,t=11.082,P<0.001)and background FI(39.42±21.06,t=14.672,P<0.001).Gender(t=1.010,P=0.314),surgical method(t=-0.515,P=0.607),age(rs=-0.129,P=0.159),height(rs=0.131,P=0.153),weight(rs=0.163,P=0.075),BMI(rs=0.081,P=0.377),preoperative blood calcium(rs=0.062,P=0.498),preoperative PTH(rs=-0.091,P=0.322),preoperative CT(rs=0.122,P=0.185)had no effect on standardized parathyroid gland FI.There were differences in the standardized parathyroid FI between different disease types(F=2.650,P=0.037).The standardized parathyroid FI(0.78 ± 0.20)of SHPT was significantly lower than that of PTC(2.03±1.00,t=-3.026,P=0.003),PTC combined with NG(1.71±0.54,t=-2.050,P=0.043),and NG(1.98±0.63,t=-2.392,P=0.018),and was not significantly different from that of PHPT(1.73±0.62,t=-1.753,P=0.082),the rest of the disease types are standardized between two pairs of parathyroid FI There was no difference(P>0.05).There was no difference between standardized parathyroid FI in other disease types(P>0.05).Compared with SHPT standardized parathyroid FI,the ? value of PTC was 1.247,95%CI was(0.431,2.064),P=0.003;the ? value of PTC combined NG was 0.927,95%CI was(0.031,1.823),P=0.043;the ? value of NG was 1.194,95%CI was(0.205,2.183),P=0.018;the ? value of PHPT was 0.950,95%CI was(-0.123,2.023),P=0.082.ConclusionsNIRF can significantly improve the recognition efficiency of parathyroid glands during operation.Except for SHPT,standardized parathyroid FI is hardly affected by other clinical variables and can be widely used in clinical practice. |
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